[shepard808]

Dr. Bill,

I tested positive for alcohol but did not consume. The lab report indicates as follows:

ETG negative (cutoff 500 ng/ml)
ETS positive (cutoff 100 ng/ml)
ETS level 120
Creatine 176.1
All else normal

I am prescribed a lidoderm patch. I think it says it contains 35% ethanol.

Can this be the patch?

Thanks

[DrBill100]

Please provide any other data that is on the report (not your identity) including the testing laboratory and instrument or method used.

Who is questioning this reading? When normalized to creatinine (176) this should not be interpreted as positive. Well below cutoff (68). It is very important to make that adjustment in low level readings (under 20,000 ng)

At that very low reading there are literally thousands of potential causes for EtS.

This finding should be summarily dismissed because the fact that the amount was quantified (120) indicates a confirmatory test was run and that test did not detect EtG which is always produced in greater amounts than EtS.

Here is a link to Dr. Greg Skipper's site. You may want to read this and see the importance of this process.

Ethylglucuronide/Ethyl Sulfate

Regarding your question about the alcohol containing transdermal patch. Yes it could be responsible for the reading. While there is no specific research relating to same, Dr. Skipper provided testimony in a court case wherein he noted "topical alcohol on joints" of the subject had resulted in an EtG reading of 1500 ng. (see Miller v. Redwood, testimony of Skipper)

[shepard808]

Dr. Bill,

Thank you for your response. Other relevant data on lab test (as far as I can tell)

Testing lab: Norchem drug testing lab in flagstaff Arizona

Method used: not listed on report. Indicates test performed under CAP-FUDT certificate

A state probation officer testing is calling this a positive based on lab report. Footnote on report indicates that ETG negative and ETS positive are consistent with alcohol consumption.

There is no indication of any normalized or modification of the ETS level (120) for urine concentration. How can I find a commonly accepted formula for this? Is this standard practice for labs to normalize based on creatine level?

Thank you for the link to Dr. Skipper's site.

[DrBill100]

Dr. Bill,

Thank you for your response. Other relevant data on lab test (as far as I can tell)

Testing lab: Norchem drug testing lab in flagstaff arizona

Method used: not listed on report. indicates test performed under CAP-FUDT certificate

A state probation officer testing is calling this a positive based on lab report. Footnote on report indicates that ETG negative and ETS positive are consistent with alcohol consumption.

There is no indication of any normalized or modification of the ETS level (120) for urine concentration. How can I find a commonly accepted formula for this? Is this standard practice for labs to normalize based on creatine level?

Thank you for the link to Dr. Skipper's site.

Skippers site contains the formula (click on the highlighted blue section at top) and most labs do not normalize despite universal research recommendations to do so.

The statement that an isolated EtS reading of 120 ng is consistent with alcohol consumption is absurd, a distortion and misapplication of what little scientific evidence exists.

In fact, "low level positives (under 2,500ng/ml) can occur more often* from incidental exposure" See Skipper

I am deferring to Dr. Skipper because he introduced this test to the US, was then and continues to be, the primary proponent of it's use. Furthermore, he is the recognized authority in relation to the test and information from his office greatly influences it's use, per advisory(ies).

My information, is anonymous and while I am, in fact, an expert in this field you must place reliance on recognized, verifiable and scientifically acknowledged resources. So please take the time to read Dr. Skipper's information. I also recommend contacting him via the e-mail address provided on the website.

If you take the time to read his website, Dr. Skipper makes the best argument for negating the validity of this test. Specifically, at values far in excess of your reading, even when both metabolites are present, he unequivocally states "EtG/EtS not Proof of Drinking"

I would advise you to protest this finding, in writing, with a copy to the laboratory; a copy to College of American Pathologists (CAP); Substance Abuse & Mental Health Services Administration (SAMHSA). I have previously provided a complaint process for false positives See Lab Complaints, post #10.

Even though this test result is self-negating you should offer, insist upon, taking another form of confirmatory testing, PEth preferred, but any combination of blood assay many of which offer a longer detection period.

Please understand that you are at an extreme disadvantage. You must be very aggressive in your protest. You must force their hand.

I am not throwing you away or discouraging further contact. I will be happy and anxious to answer any questions that emerge, Dr. Skipper or otherwise (certainly we disagree on many points). Now it is incumbent on you to cut through all of the circumlocution so common to this test. All of the factual data is in your favor.

*emphasis added

[shepard808]

Hi,

Thanks for the response. I communicated with the lab asking for the normalization of the result based on creatine. I also asked for a PEth test. This is the response.

We do not provide PEth testing at this time. As far as we know, most of the work on PEth has been done with blood.

Normalizing results is useful for determining new use between tests for fat soluble drugs, such as THC, which can stick around in the body for extended periods.

Drug levels we report are by nanogram per milliliter (ng/ml) and the creatinine level is reported by milligram per deciliter (mg/dl), two different units of measurement. The number 68 is only the ratio- a statement of how two numbers compare, not the level of EtS. Our laboratory has not determined the usefulness of normalizing EtG/EtS levels, particularly since the window of detection is only approximately 3 days.


I am not sure where to go from here. Thanks. Guy Skipper answered my email and indicated the same as you that number was a very low positive as suspect.

Thanks again.

[DrBill100]

I probably didn't clarify PEth sufficiently above. It is in fact a blood test.

I believe you are getting an evasive response from the lab. Of course the EtG to creatine is a ratio. But creatinine is a measure of urine concentration and the more concentrate your urine the higher the EtG reading.

The fact that the lab hasn't "determined the usefulness of normalizing" is somewhat astounding as every researcher since 2006, worldwide, has used and recommended the process in interpreting EtG/EtS timelines and quantities.

What do you think it would take to educate this probation officer to the facts. What action do they intend to take?

There is a great deal of research on EtG, less on EtS since it wasn't widely used until the last 5 years.

This is a misuse and misinterpretation of the capabilities of this unreliable and unscientific test.

Continue to correspond with all involved in writing, use the complaint list I provided, and copy Dr. Skipper as well.

To demonstrate just how low this reading is, Thierauf, 2009 studied the amount of EtG and EtS that is created by very small amounts of alcohol (1g and 3g) "which are more likely to be incidental than intended." Your reading 120 ng/ml is 30ng less than was found after 1g of EtOH. A trace amount (As example, one standard drink contains 14g of pure alcohol.) It should be further noted that these results were after normalization to creatinine.

See Thierauf A, Halter CC, Rana S, Auwaerter V, Wohlfarth A, Wurst FM, Weinmann W (2009) Urine tested positive for ethyl glucuronide after trace amounts of ethanol. Addiction 2009 Dec;104(12):2007-12